A groundbreaking liver transplant on an HIV-negative child from her HIV-positive mother might pave the way to changing policies around organ donation.
Health Minister Dr Aaron Motsoaledi yesterday said the child’s liver transplant might be used as a case study to influence organ donation policies.
Currently, it is not considered good practice for living HIV-positive people to donate their organs.
This might change after a mother donated her liver to her 13-month-old child who was critically ill.
Motsoaledi said: “We will have to look at the policies and see how they can be changed.
“The researchers will have to be part of that discussions.”
He said if researchers find that HIV-positive people can donate their organs, it might go a long way in addressing organ shortages in the country.
In what is believed to be the first in the world, researchers at Wits University performed the procedure.
The child and her mother cannot be identified in line with doctor-patient privacy.
Doctors at Wits Donald Gordon Medical Centre said the child had biliary atresia and needed a liver transplant.
As a result of a shortage of donated organs, the critically ill child couldn't get one.
The mother volunteered to donate the liver. The doctors weighed their options and after the child was on the waiting list for 180 days, they went ahead with the transplant.
Before the transplant, the child was given pre-exposure prophylaxis - medication to protect at risk individuals from contracting HIV - and was placed on ARVs after the procedure.
Professor Jean Botha, director of transplantation at the transplant unit at Donald Gordon, said after surgery they worked on the basis that the child would be infected with HIV.
After tests with the help of the National Institute for Communicable Diseases, no HIV antibodies have been found in the child's bloodstream so far. The baby is currently on ARVs and the doctors will make a decision in the future on whether to continue with the treatment or not.
“For now, the child will remain on ARVs until we have a more comprehensive picture,” Professor Caroline Tiemessen, Researcher Professor at the Wits School of Pathology, said.
Wits has been running the living donor liver transplant programme - the only one in southern Africa - since 2013. The University of Cape Town has a programme that performs kidney transplants from deceased HIV positive people to HIV negative people with good results.
Dr Harriet Etheredge, who oversees the ethics and regulatory issues at Donald Gordon, said there were a lot of ethical problems to worry about before the transplant.
“Extensive efforts were made to identify either a deceased liver donor or an HIV negative living donor for the child before considering an HIV positive parent donor. Transplanting HIV positive organs is not illegal in South Africa, however, it is not considered best practice internationally because of the risk of HIV transmission to the recipient. This operation is offered only under exceptional circumstances,” she said.